Discovery
Health Medical Scheme is aware of an article published in The Star newspaper of
8 August on one of our members, Ms Thobeka Xaba, and our support for her during
her cancer treatment. The article
misrepresents Discovery Health Medical Scheme’s support for Ms Xaba during her
six-year long battle with cancer and we would like to give the correct facts of
the case.

Discovery
Health Medical Scheme has always put Ms Xaba’s health first, having funded her
cancer treatment in full for the past six years until earlier in the year, when
her oncologist requested a new treatment.

Evaluating
new healthcare treatments is complex, and Discovery Health Medical Scheme’s
approach is to defer to the leading independent experts in the field to ensure
that the care our members receive is the best and most appropriate. We hence referred Ms Xaba’s case to leading
academic oncology specialists to review and give advice on whether the new treatment
should be covered. The feedback from this panel was clear – that there is no published
clinical evidence that the drug would be effective or safe for this patient’s
condition, and that there are other safe and effective treatments, which would be
covered in full by Discovery Health Medical Scheme.

Importantly,
the decision was not a financial one, but one that places Ms Xaba’s health as
the top priority. On this basis, Discovery Health Medical Scheme proposed more
expensive treatment regimens as alternatives that we would cover in full. Contrary
to what was reported in the Star article on 8 August, Discovery Health Medical
Scheme did not recommend that Ms Xaba continue on the prior medication which
her doctor wished to stop. The recommendations from the Scheme were for new
alternatives that would be funded in full, and for which there was clear
evidence.

Oncology
treatment regimens are complex, and Discovery Health was at all times open to
engaging with Ms Xaba’s doctor to find the appropriate solution that would
achieve the best quality of care for our member.

The case was referred to the Council for Medical Schemes for resolution.
Earlier today, Discovery Health Medical Scheme attended an appeals hearing at
the Council for Medical Schemes which was convened on an urgent basis. Whilst
the appeal ruling is awaited, the following came to light during the appeal
hearing:

Ms Xaba’s treating
oncologist immediately conceded that the treatments that Discovery Health
Medical Scheme had been suggesting were acceptable, and that her patient could
be treated with these immediately.

She also
conceded that she is not up to date with the South African Oncology Consortium
medicine tiers and protocols. She was unable to give an adequate explanation of
why she refused to discuss these alternatives with her patient and Discovery
Health Medical Scheme for over two months.

The oncologist
acknowledged that she had not advised the media and Discovery Health Medical
Scheme regarding the treatment Ms Xaba has been receiving. Whereas the doctor
told the media that the patient had not been on any treatment for the past two
months, and that her life was in danger, the doctor today told the hearing that
the patient had in fact been on treatment over this whole period.

It is clear
that this medication was inappropriate based on the views of some of the
country’s leading experts.

Discovery Health Medical Scheme has reconfirmed to Ms Xaba that her
treatment plan recommended by our independent specialist panel will be funded in
full, as it has been for the past six years. We are pleased to confirm that Ms
Xaba will now recommence the appropriate treatment and we will continue to
support her to the best of our ability.

More about Discovery Health Medical Scheme’s cover for
cancer treatment

Discovery
Health Medical Scheme offers the most comprehensive cancer treatment programme of
any medical scheme in South Africa

Cancer affects
millions of people in South Africa, and as one of the largest healthcare
funders in our country, we offer the most comprehensive cancer treatment
programme in South Africa.

We
currently have over 35 000 members in our care who are undergoing cancer
treatment. Over the past year Discovery Health Medical Scheme covered over R1
billion of cancer treatment for our members with 99% of treatment covered in
full. In addition, we covered R1.3 billion of non-cancer treatment for our
cancer patients.

We make funding decisions based on the
best clinical advice and evidence available in the industry

As
a healthcare funder, our primary responsibility is always to protect our
members and do what is right for them. This means ensuring that members receive
appropriate medical treatment according to the benefits on their plan. In cases
where exceptions are made, these decisions about funding must be made according
to the best clinical evidence that is available. It is important to understand
that as medicine become more complex – not only in South Africa but also
globally – healthcare professionals and health systems are continuously working
to use the best available clinical evidence and protocols to determine what
type of treatments will be effective for which conditions. This is particularly
important for cancer treatment, where science and technology are evolving at a
very fast rate. This makes it difficult to for individual healthcare
professionals to remain abreast of the latest clinical evidence.

For this reason,
Discovery Health Medical Scheme uses the best external medical advice and published
evidence in all complex cases, including cancer cases, to determine how to fund
treatment. This is important given the complexity of
various treatments and medicine.

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Comments (1)

Well done, Discovery!! My wife suffered from a very rare cancer of the colon and Discovery paid in full for her treatment, even when new, unproven medicine was used by the Oncologist in association with Discovery. She passed away after 6 and a half years of treatment.
Thank you, Discovery, for providing not only excellent treatment, but also peace of mind to the family! Dr PF de Wet, Bluewater Bay, Port Elizabeth